Diabetic Neuropathy Peripheral neuropathy is a disorder involving the peripheral nervous system (PNS). The central nervous system (CNS) includes your brain and spinal cord, and the PNS includes all of the nerves that come from your spinal cord and innervate the rest of your body. Peripheral neuropathy can be caused by many conditions including vitamin deficiencies, alcoholism, autoimmune diseases, certain medications, unknown causes, and from diabetes. When your peripheral nerves become damaged, they do not function properly, and can eventually produce symptoms such as pain, tingling, or numbness.
Diabetes can be broken down into two main types: Type I: Insulin Dependent and Type II: non-Insulin Dependent Diabetes Mellitus. Over time, Type II DM patients may become insulin requiring but are still labeled Type II. Type I is seen most commonly in children and is due to a possible immunological cause, whereas as Type II is caused by an acquired insulin resistance. Type II DM is frequently seen in obese patients and results when their bodies become resistant to their own insulin (hormone that controls your blood sugar). Patients with Type II DM must be educated about the types of foods that affect their blood sugars. By eating well-balanced foods in the correct amounts, you may be able to maintain your blood sugar levels close to normal and reduce the risk of the many detrimental consequences of diabetes.
Exercise is also extremely important in patients with diabetes. When a person exercises, their muscles use sugar for energy. With strenuous exercise the body breaks down sugar for energy and blood sugar levels decrease. Exercise can also increase your sensitivity to insulin. The first line of treatment in patients with newly diagnosed Diabetes Type II is diet, exercise, and weight loss because this may prevent the need for pharmacologic medication. When a person cannot control their blood sugar through diet and exercise, then medications are required. Diabetes is a severe risk factor for cardiovascular disease, peripheral neuropathy, kidney disease, and retinopathy (affecting the eyes), so strict blood sugar control is crucial for preventing these and other diabetes-related complications.
Patients who do not have a tight glucose control eventually have the complications associated with diabetes (Smith 2007). An excess amount of sugar in the blood injures of the capillary walls (small blood vessels) that supply your nerves, especially in your hands and feet. This destruction can cause nerve damage that may manifest as pain, numbness, or tingling that usaually begins in the toes and move proximal (towards to head). Erectile dysfunction is also common in men with poorly controlled diabetes as these blood vessels are damaged too. Another complication from the nerve damage produced by Diabetes is a neuropathy involving the gastrointestinal system. Damage to these nerves can cause problems with nausea, vomiting, diarrhea and/or constipation. Postural hypotension may also ensue due to a progression of your peripheral neuropathy.
Diabetic peripheral neuropathy can be difficult to diagnose. Certain lab tests may be ordered by your physician in order to rule out other potential causes of peripheral neuropathy such as Vitamin B12. Nerve conduction studies as well as an electromyography (EMG) may also help your physician make your diagnosis. Often times, diabetic peripheral neuropathy is based on exclusion of other possibilities and a strong history that is suggestive of it.
Even more difficult than diagnosing Diabetic peripheral neuropathy, is treating it. The goal of treatment is to control the blood sugar level that is causing your neuropathy, and provide symptom relief. There are no quick fixes for diabetic peripheral neuropathy so your physician may recommend several different things until you find which is most effective for you, including pharmacologic and no pharmacologic therapies (Smith 2007). Most importantly, maintaining normal blood sugar levels is the first line of treatment and prevention for diabetic peripheral neuropathy.
Membrane stabilizing medications are typically the drug of choice used to treat painful neuropathies. These medications typically “calm down irritated nerves,” but can have a high rate of side effects that may limit their use. Some of the medications which are particularly effective treating nerve pain include: Cymbalta, Elavil, Lyrica, Tramadol, and Neurontin. These medications may relieve pain, but do not help to prevent the progression of the disease.
Pain relievers, such as NSAIDs and opiates may offer some pain relief, but there is a concern of overuse and dependence that may develop along with other side-effects. Opioids are usually not the drug of choice when treating nerve pain.
Some alternative therapies that are used to treat diabetic peripheral neuropathy include:
• Nutrient and Vitamin supplements
– Certain nutritional supplements have been
implicated in helping to treat and prevent neuropathies. Working closely with a nutritionist or physician, you can come up with a diet or supplements that may benefit your neuropathy. Alpha-lipoic acid, acetyl-L-carnitine, benfotiamine, methylcobalamin, and topical capsaicin are among the well-researched alternative options for the treatment of peripheral neuropathy.
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